Frequently Asked Questions
What does TPOPP stand for?
TPOPP stands for Transportable Physician Orders for Patient Preferences.
What is a TPOPP Form?
A TPOPP form is a doctor’s order that helps you keep control over medical care at the end of life. Like a Do Not Resuscitate (DNR) order, a TPOPP form tells emergency medical personnel and other health care providers whether or not to administer cardiopulmonary resuscitation (CPR) in the event of a medical emergency. A TPOPP form may be used in addition to-or, sometimes, instead of – a DNR order. The TPOPP form may also provide other information about your wishes for end of life health care.
Who may want to complete a TPOPP form?
Patients with advanced, chronic, progressive illness (ex: chronic obstructive pulmonary disease, diabetes, heart disease, alzheimer’s, etc) or terminal illness. Any individuals may complete a TPOPP form who wish to further define their treatment preferences for end of life care beyond advance directives.
Why do we need a TPOPP form?
The form is designed to improve the quality of care people receive at the end of life by translating their treatment goals and preferences into their medical orders. The form is used to indicate a patient’s preference for receiving or limiting medically indicated treatments. This form will also provide a uniform, transportable document in the continuum of care from home, doctor’s office, EMS and hospital admissions.
How do I get a TPOPP form?
TPOPP forms will be available in Wichita starting in April 2014. A health care professional can help you create a TPOPP form if you enter a participating medical facility or health care setting. To be valid, the TPOPP form must be signed by a physician. If a member of the medical staff does not ask you whether you want to create a TPOPP form, you may ask for one.
Are other states using TPOPP?
TPOPP is modeled on POLST (Physician Orders for Life Sustaining Treatment) developed in the 1990s. TPOPP emphasizes “patient preferences” and is one of more than 30 such efforts currently underway nationally to address end of life issues.
Do you have a supporting agency for TPOPP?
This is a Kansas-Missouri initiative sponsored by the Center for Practical Bioethics with the support of the University of Kansas Medical Center and many community based organizations. The Center for Practical Bioethics is coordinating TPOPP projects with training, monitoring and evaluation tools. In Wichita, the TPOPP initiative has the support of Wesley Medical Center, Via Christi Health, Bob Dole Veterans’ Administration Hospital and the Medical Society of Sedgwick County.
Why do I need this TPOPP form if I already have advance directives (DPOA-HC, Living Will and Do Not Resuscitate forms)?
A TPOPP form is a physician’s order sheet and can clarify your intentions for treatment at your end of life. The form is more specific about some elements of care and minimizes confusion regarding your care preferences. Also, because it is part of your permanent medical records, it easily transfers from one health care facility to another if that it becomes necessary.
How does a TPOPP Form differ from other health care directives?
A TPOPP form differs from a DNR Order in one important way: A TPOPP form includes directions about life-sustaining measures in addition to CPR, such as intubation, and feeding tubes. The TPOPP form helps medical providers understand your wishes for end of life care at a glance, but it is not a substitute for a properly prepared Living Will and Durable Power of Attorney for Health Care Decisions.
Do institutions, professional associations and other healthcare entities endorse the implementation of the TPOPP initiative?
TPOPP Wichita is endorsed by the following through members serving on the TPOPP Wichita Steering Committee and through state organizations:
- Central Plains Area Agency on Aging
- Harden Hospice
- Harry Hynes Memorial Hospice
- Kansas Academy of Family Physicians
- Kansas Hospital Association
- Kansas Medical Society
- Society of Sedgwick County
- Presbyterian Manors of Mid-America
- RiverCross Hospice
- Robert Dole VA Medical Center
- Sedgwick County Emergency Medical Services
- Sedgwick County Emergency Medical Services System
- Via Christi Health
- Wesley Medical Center
- Wichita Fire Department
Can a physician who does not have privileges at the hospital send a TPOPP form with the patient from a nursing home or physician’s office?
Yes, the TPOPP form serves as a physician’s order sheet, and indicates the orders for the patient in any other facility and different levels of care.
Can a patient in Wichita-Sedgwick County transfer the TPOPP to use in other communities in Kansas or other states?
Yes, the TPOPP form can serve as a “physician’s order sheet” to the next entry of care, even if that community does not have a TPOPP initiative. The TPOPP form serves as a continuum of care for the patient’s wishes and the physician’s order sheet to inform the next physician of the current order information for the patient.
How legally binding is the TPOPP form?
TPOPP is based on the belief that individuals have the right and the responsibility to make their own health care decisions.
The TPOPP form is representing the wishes of the patient and is signed by the patient themselves, a family representative, or the health care agent acting under a Durable Power of Attorney for Health Care (DPOA-HC). This TPOPP form is based on communication between the physician and the patient or their representative. In Kansas, the TPOPP form is not statute based. It is a doctor’s order sheet.
Do all sections of the TPOPP form need to be completed?
No, a patient or family representative/ or DPOA-HC can complete the sections that apply to the decisions made by/for the patient.
Is the TPOPP form in use because of the Affordable Care Act?
No, the TPOPP and POLST forms began in the 1990’s and the Affordable Care Act changes in health care in 2012.
Why was the color pink chosen for the form?
The pink color stood out among white forms.
What do I (health care professional) do if I am presented with a TPOPP form and an advance directive?
Follow the policies of your institution. Usually, these documents are scanned into the medical record at the health care facility and made a part of the medical record. The documents presented by the patient and/or DPOA-HC belong to the patient and should be returned to the patient.
Can a Durable Power of Attorney for Health Care withdraw/change a TPOPP form?
Yes, a DPOA-HC can update the TPOPP form and void the previous dated form if decisions have changed. The TPOPP form is hopefully reflecting the patient’s wishes.
Can a guardian change the TPOPP form?
Note section D on TPOPP form: Information and Signatures. A legal guardian may discuss the TPOPP form with the health care professionals. So, yes, a legal guardian can change the TPOPP form. A legal guardian by KS law cannot withdraw life-sustaining treatments (LST), so a DNR (restricting use of resuscitation) and withdrawal of or not using LST (including ex: feeding tubes, dialysis) would require going to court with a physician’s letter and thus a judge to give the guardian the power to withdraw/withhold LST’s.
Is the TPOPP form like a Living Will?
Yes, in a way. However, it is more definitive about end of life care for a person with chronic, advanced illness and/or terminal illness.
Will the ER Physicians honor the TPOPP form?
We hope so! ER Physicians will be oriented to the TPOPP form and will ask for the advance directives and TPOPP form on admission (if appropriate). First responders (EMS and firefighters) should also ask for the advance directives and TPOPP form on arrival at the site of care.